Explanation of Benefits (EOB) Processing with Peslac

Explanations of Benefits (EOBs) are vital documents in the insurance ecosystem, connecting providers, payers, and patients. Peslac's AI-powered document processing system brings unprecedented clarity to these often complex communications.

Advanced Document Analysis

Our AI technology meticulously examines EOBs, including:

• Claim details
• Benefit calculations
• Patient responsibilities
• Appeal rights

The system builds a nuanced understanding of your insurance organization's documentation practices, adapting to both standardized formats and payer-specific variations.

Custom Workflow Creation

Peslac's innovative tool builder empowers claims teams with:

• Precise extraction parameter definition
• Multi-layered validation checks
• Automated routing based on claim complexity and member inquiries

Field-Level Data Extraction

Our system excels at handling insurance documentation intricacies:

• Recognizes complex relationships between services, allowed amounts, and cost-sharing
• Maintains accuracy with challenging elements like coordination of benefits and bundled services
• Processes plan-specific exclusions with precision

Consistent Multi-Source Processing

Peslac's engine handles EOBs from diverse payers and plan types:

• Navigates varying document structures
• Manages provider-specific coding
• Adapts to evolving healthcare reimbursement models
• Performs real-time cross-referencing against policy data
• Validates extracted information against current benefit structures

Measurable Impact

Insurance organizations using Peslac's solution report:

• 85% faster EOB processing compared to traditional methods
• Improved operational stability during high claims volume periods
• Significant improvements in inquiry resolution times
• Reduced appeals due to clearer benefit explanations

Comprehensive Audit Trails

Our platform maintains meticulous processing records for:

• Financial audits
• Regulatory compliance
• Continuous system improvement through user feedback

Integration and Data Flow

• Secure, HIPAA-compliant APIs enable integration with existing claims management systems
• Processed data automatically populates:
  • Member portals
  • Provider communication platforms
  • Analytics tools

This eliminates redundant data entry and minimizes discrepancies that could impact member satisfaction or provider relations.

Scalable Performance

Peslac's solution adapts to:

• Fluctuating claims volumes
• New plan offerings
• Processing hundreds to thousands of EOBs daily
• Handling ancillary documentation like medical records and pre-authorization forms

Analytical Insights

Our platform's analytics capabilities reveal:

• Claims patterns
• Process improvement opportunities
• Processing times
• Denial rates
• Member inquiry trends across plan types and provider networks

This data informs targeted interventions to enhance claims accuracy and optimize member communication strategies.

Robust Security Measures

Data security remains paramount throughout EOB processing:

• Rigorous access controls
• Comprehensive audit trails
• HIPAA compliance
• Data protection measures for transmission and storage
• Granular permissions and proactive monitoring

Peslac's document intelligence brings tangible improvements to benefits administration and member satisfaction. Insurers report clearer benefit communications, reduced call center volume, and improved provider relations due to more accurate and timely EOB processing.